I have some concerns about the cleaning of bicarb jugs and would like some input. If you still use jugs in your facility, how often do you bleach them? Do you rinse in RO or tap water? How long do you let them dry? How do you clean and store the wands for the bicarb jugs? Do you have a method to keep them clean, or are they just laid on a mostly-clean surface to dry? Thanks much!!

Don't use them anymore, but back in the day we would bleach them every night (just use the water from the bicarb mix tank if you use one). Rinsing with tap water would be kinda pointless (chlorine/chloramine). We fabricated a rack out of sch 40 pvc to store the jugs upside down and dry them. The wands were just submersed in a diluted bleach solution (same concentration as the jugs) and then rinsed thoroughly. Then, they were put in a mesh basket on the wall to air dry. Kinda tedious but it does the job. Hope that answers your question. Good luck!!

Bicarb jugs unfortunitly are given the least attention in most units. In my unit we have jugs on stand-by incase of problems with our delivery sytem and use them in our acute unit. We ozone disinfect every jug and wand once a week and store them on a rack inverted. The important thing here is to keep the insides dry. In our acutes unit we bleach disinfect twice a week. Checking cultures on a percentage is also done to see if frequany is adaquate.Never use tap water, thats an invitation to growth problems etc, stc. Hope I helped.

The suggestions for disinfecting the jugs regularly with bleach or ozone, rinsing them well and drying them out up side down (especially) are excellent. However I must correct the statement that a tap water rinse could lead to chlorine, chloramine problems. Even if the tap water contained 5 ppm chloramines, and as much as 10 ml of rinse water were left in the jug, this would later yield only a concentration of 0.006 ppm chloramine after subsequently adding 8 liters of purified water. The threat of tap water rinse contamination is with bacteria and endotoxins, not chemicals in the water.

Stephen,

I agree with you 100% as far as it being safe to use tap water BUT, we were cited by CMS for using tap water for this.

Chuck

Thank you for the replies. My facility currently rinses bicarb jugs and wands in tap water, lets them dry for a couple hours (with the wands tossed onto a towel, on a wooden shelf, in contact with a box on one side and vinegar jugs on the other, or stuffed down the handle of the PVC cart that is used to transport the jugs.) They mix bicarb in the afternoon, fill the jugs, and let them sit overnight for use the next day. The bicarb is usually a little over 24 hours old before the end of treatment for our latest patients. We have had positive tests for gram negative bacteria about 3 times in the last year, always from the machines, not from the water system. I strongly believe that the handling of the bicarb jugs and wands, plus letting it sit overnight, is the culprit. However, since "they have always done it this way," ever with the backing of our Infection Control Officer, I can't convince them to be more careful. It doesn't help that I'm only the tech, and therefore have no authority. If anyone knows of PRINTED proof that tap water should not be used this way, I would really appreciate knowing where it is. Again, thanks!!

Boy, I think your problem is not so much the rinsing with tap water, but the making of the bicarb the night before. Bicarb is a great growth medium for bacteria, and combined with the rinsing with tap water, you have a bad combination. We use diluted Renalin from our bicarb tanks once per week to disinfect both wands and jugs. They sit over the weekend and are rinsed on Monday. We never have problems with our cultures - and have practiced this way for the 10 years I have been with this unit. We mix bicarb in the morning for that day's treatments and dump any leftovers at the end of the night. The jugs and wands are rinsed with RO water and left to air dry over night. The jugs on a rack upside down and the wands on a clean towel on the stainless sink. Is the Medical Director aware and OK with this? Or is he even involved? I would be concerned about patient reactions to this mix.....

Here is a web address that you can order information on mixing bicarb and cleaning jugs. It's from Church & Dwight Co. the makers of sodium bicarbonate for dialysis. It's free of charge all you have to do is call and request it. Also it comes with a continuing education program for nurses, offering 2.0 contact hours. http://www.annanurse.org/resource/corpmem/candd.htm

As of Sept 2003, new TDH rules, which are adopted AAMI guidelines, state that bicarb jugs now need to be bleached AT LEAST once weekly and rinsed with RO water and inverted when drying, not lying on the side.

Bicarbonate jugs, when connected to the dialysis machine, become part of the dialysis delivery system. Daily disinfection of bicarbonate jugs is recommended by the CDC.

quote:

Originally posted by pato:
Bicarbonate jugs, when connected to the dialysis machine, become part of the dialysis delivery system. Daily disinfection of bicarbonate jugs is recommended by the CDC.

According to the Texas Licensure Regulations adopted in 2003, "Bicarb jugs must be rinsed and inverted to drain each day, and disinfected weekly." Yes, the previous regulation was daily, but since Sept, 2003, the new regulation is stated above.